item-0 at level 0: unspecified: group _root_
  item-1 at level 1: title: Evolving general practice consul ...  Britain: issues of length and context
    item-2 at level 2: paragraph: George K Freeman, John P Horder, ... on P Hill, Nayan C Shah, Andrew Wilson
    item-3 at level 2: paragraph: Centre for Primary Care and Soci ... ersity of Leicester, Leicester LE5 4PW
    item-4 at level 2: text: In 1999 Shah1 and others said th ...  per consultation in general practice?
    item-5 at level 2: text: We report on the outcome of exte ...  review identified 14 relevant papers.
    item-6 at level 2: section_header: Summary points
      item-7 at level 3: list: group list
        item-8 at level 4: list_item: Longer consultations are associa ... ith a range of better patient outcomes
        item-9 at level 4: list_item: Modern consultations in general  ... th more serious and chronic conditions
        item-10 at level 4: list_item: Increasing patient participation ...  interaction, which demands extra time
        item-11 at level 4: list_item: Difficulties with access and wit ... e and lead to further pressure on time
        item-12 at level 4: list_item: Longer consultations should be a ... t to maximise interpersonal continuity
        item-13 at level 4: list_item: Research on implementation is needed
    item-14 at level 2: section_header: Longer consultations: benefits for patients
      item-15 at level 3: text: The systematic review consistent ... ther some doctors insist on more time.
      item-16 at level 3: text: A national survey in 1998 report ... s the effects of their own experience.
    item-17 at level 2: section_header: Context of modern consultations
      item-18 at level 3: text: Shorter consultations were more  ...  potential length of the consultation.
    item-19 at level 2: section_header: Participatory consultation style
      item-20 at level 3: text: The most effective consultations ... style usually lengthens consultations.
    item-21 at level 2: section_header: Extended professional agenda
      item-22 at level 3: text: The traditional consultation in  ... agerial expectations of good practice.
      item-23 at level 3: text: Adequate time is essential. It m ...  inevitably leads to pressure on time.
    item-24 at level 2: section_header: Access problems
      item-25 at level 3: text: In a service free at the point o ... ort notice squeeze consultation times.
      item-26 at level 3: text: While appointment systems can an ...  for the inadequate access to doctors.
      item-27 at level 3: text: In response to perception of del ... ntation is currently being negotiated.
      item-28 at level 3: text: Virtually all patients think tha ... e that is free at the point of access.
      item-29 at level 3: text: A further government initiative  ... ealth advice and first line treatment.
    item-30 at level 2: section_header: Loss of interpersonal continuity
      item-31 at level 3: text: If a patient has to consult seve ... unning and professional frustration.18
      item-32 at level 3: text: Mechanic described how loss of l ... patient and professional satisfaction.
    item-33 at level 2: section_header: Health service reforms
      item-34 at level 3: text: Finally, for the past 15 years t ... ents and staff) and what is delivered.
    item-35 at level 2: section_header: The future
      item-36 at level 3: text: We think that the way ahead must ... p further the care of chronic disease.
      item-37 at level 3: text: The challenge posed to general p ... ermedicalisation need to be exploited.
      item-38 at level 3: text: We must ensure better communicat ... between planned and ad hoc consulting.
    item-39 at level 2: section_header: Next steps
      item-40 at level 3: text: General practitioners do not beh ... ailable time in complex consultations.
      item-41 at level 3: text: Devising appropriate incentives  ... and interpersonal knowledge and trust.
    item-42 at level 2: section_header: Acknowledgments
      item-43 at level 3: text: We thank the other members of th ... Practitioners for administrative help.
    item-44 at level 2: section_header: References
      item-45 at level 3: list: group list
        item-46 at level 4: list_item: Shah NC. Viewpoint: Consultation ... y men!”. Br J Gen Pract 49:497 (1999).
        item-47 at level 4: list_item: Mechanic D. How should hamsters  ... BMJ 323:266–268 (2001). PMID: 11485957
        item-48 at level 4: list_item: Howie JGR, Porter AMD, Heaney DJ ... n Pract 41:48–54 (1991). PMID: 2031735
        item-49 at level 4: list_item: Howie JGR, Heaney DJ, Maxwell M, ... BMJ 319:738–743 (1999). PMID: 10487999
        item-50 at level 4: list_item: Kaplan SH, Greenfield S, Ware JE ... c disease. Med Care 27:110–125 (1989).
        item-51 at level 4: list_item: Airey C, Erens B. National surve ... e, 1998. London: NHS Executive (1999).
        item-52 at level 4: list_item: Hart JT. Expectations of health  ... h Expect 1:3–13 (1998). PMID: 11281857
        item-53 at level 4: list_item: Tuckett D, Boulton M, Olson C, W ... London: Tavistock Publications (1985).
        item-54 at level 4: list_item: General Medical Council. Draft r ... ctors/index.htm (accessed 2 Jan 2002).
        item-55 at level 4: list_item: Balint M. The doctor, his patien ... the illness. London: Tavistock (1957).
        item-56 at level 4: list_item: Stott NCH, Davies RH. The except ...  J R Coll Gen Pract 29:210–205 (1979).
        item-57 at level 4: list_item: Hill AP, Hill AP. Challenges for ... nium. London: King's Fund75–86 (2000).
        item-58 at level 4: list_item: National service framework for c ... . London: Department of Health (2000).
        item-59 at level 4: list_item: Hart JT. A new kind of doctor: t ... ommunity. London: Merlin Press (1988).
        item-60 at level 4: list_item: Morrison I, Smith R. Hamster hea ... J 321:1541–1542 (2000). PMID: 11124164
        item-61 at level 4: list_item: Arber S, Sawyer L. Do appointmen ...  BMJ 284:478–480 (1982). PMID: 6800503
        item-62 at level 4: list_item: Hjortdahl P, Borchgrevink CF. Co ... MJ 303:1181–1184 (1991). PMID: 1747619
        item-63 at level 4: list_item: Howie JGR, Hopton JL, Heaney DJ, ... Pract 42:181–185 (1992). PMID: 1389427
        item-64 at level 4: list_item: Freeman G, Shepperd S, Robinson  ... ), Summer 2000. London: NCCSDO (2001).
        item-65 at level 4: list_item: Wilson A, McDonald P, Hayes L, C ... Pract 41:184–187 (1991). PMID: 1878267
        item-66 at level 4: list_item: De Maeseneer J, Hjortdahl P, Sta ... J 320:1616–1617 (2000). PMID: 10856043
        item-67 at level 4: list_item: Freeman G, Hjortdahl P. What fut ... MJ 314:1870–1873 (1997). PMID: 9224130
        item-68 at level 4: list_item: Kibbe DC, Bentz E, McLaughlin CP ... Pract 36:304–308 (1993). PMID: 8454977
        item-69 at level 4: list_item: Williams M, Neal RD. Time for a  ... ct 48:1783–1786 (1998). PMID: 10198490